7.4 Roles and Responsibililites of Health Care Professionals
The second IPEC competency relates to the roles and responsibilities of health care professionals and states, “Use the knowledge of one’s own role and those of other professions to appropriately assess and address the health care needs of clients and to promote and advance the health of populations.”[1]
See the following box for the components of this competency. It is important to understand the roles and responsibilities of the other health care team members; recognize one’s limitations in skills, knowledge, and abilities; and ask for assistance when needed to provide quality, client-centered care.
Components of IPEC’s Roles/Responsibilities Competency[2]
- Communicate one’s roles and responsibilities clearly to clients, families, community members, and other professionals.
- Recognize one’s limitations in skills, knowledge, and abilities.
- Engage with diverse professionals who complement one’s own professional expertise, as well as associated resources, to develop strategies to meet specific health and health care needs of clients and populations.
- Explain the roles and responsibilities of other providers and the manner in which the team works together to provide care, promote health, and prevent disease.
- Use the full scope of knowledge, skills, and abilities of professionals from health and other fields to provide care that is safe, timely, efficient, effective, and equitable.
- Communicate with team members to clarify each member’s responsibility in executing components of a treatment plan or public health intervention.
- Forge interdependent relationships with other professions within and outside of the health system to improve care and advance learning.
- Engage in continuous professional and interprofessional development to enhance team performance and collaboration.
- Use unique and complementary abilities of all members of the team to optimize health and client care.
- Describe how professionals in health and other fields can collaborate and integrate clinical care and public health interventions to optimize population health.
Nurses communicate with several individuals during a typical shift. For example, during inpatient care, nurses may communicate with clients and their family members; pharmacists and pharmacy technicians; providers from different specialties; physical, speech, and occupational therapists; dietary aides; respiratory therapists; chaplains; social workers; case managers; nursing supervisors, charge nurses, and other staff nurses; assistive personnel; nursing students; nursing instructors; security guards; laboratory personnel; radiology and ultrasound technicians; and surgical team members. Providing holistic, quality, safe, and effective care means every team member taking care of clients must work collaboratively and understand the knowledge, skills, and scope of practice of the other team members. Table 7.4 provides examples of the roles and responsibilities of common health care team members that nurses frequently work with when providing client care. To fully understand the roles and responsibilities of the multiple members of the complex health care delivery system, it is beneficial to spend time shadowing those within these roles.
Table 7.4. Roles and Responsibilities of Members of the Health Care Team
| Member | Role/Responsibilities |
|---|---|
| Unlicensed Assistive Personnel (UAP) (e.g., certified nursing assistants [CNA], patient-care technicians [PCT], certified medical assistants [CMA], certified medication aides, and home health aides) | Work under the direct supervision of the RN. (Read more about Unlicensed Assistive Personnel (UAP) in the “Delegation and Supervision” chapter.) |
| Licensed Practical/Vocational Nurses (LPN/VN) | Assist the RN by performing routine, basic nursing care with predictable outcomes. (Read more details in the “Delegation and Supervision” chapter.) |
| Registered Nurses (RN) | Use the nursing process to assess, diagnose, identify expected outcomes, plan and implement interventions, and evaluate care according to the Nurse Practice Act of the state they are employed. |
| Charge Nurses or Nursing Supervisors | Supervise members of the nursing team and overall client care on the unit (or organization) to ensure quality, safe care is delivered. |
| Directors of Nursing (DON), Chief Nursing Officer (CNO), or Vice President of Patient Services | Ensure federal and state regulations and standards are being followed and are accountable for all aspects of client care. |
| Clinical Nurse Specialist (CNS) | Practice in a variety of health care environments and participate in mentoring other nurses, case management, research, designing and conducting quality improvement programs, and serving as educators and consultants. |
| Nurse Practitioners (NP) or Advanced Practice Registered Nurses (APRN) | Work in a variety of settings and complete physical examinations, diagnose and treat common acute illness, manage chronic illness, order laboratory and diagnostic tests, prescribe medications and other therapies, provide health teaching and supportive counseling with an emphasis on prevention of illness and health maintenance, and refer clients to other health professionals and specialists as needed. NPs have advanced knowledge with a graduate degree and national certification. |
| Certified Registered Nurse Anesthetists (CRNA) | Administer anesthesia and related care before, during, and after surgical, therapeutic, diagnostic, and obstetrical procedures, as well as provide airway management during medical emergencies. |
| Certified Nurse Midwives (CNM) | Provide gynecological exams, family planning guidance, prenatal care, management of low-risk labor and delivery, and neonatal care. |
| Medical Doctors (MD) | Licensed providers who diagnose, treat, and direct medical care. There are many types of physician specialists such as surgeons, pulmonologists, neurologists, cardiologists, nephrologists, pediatricians, and ophthalmologists. |
| Physician Assistants (PA) | Work under the direct supervision of a medical doctor as licensed and certified professionals following protocols based on the state in which they practice. |
| Doctors of Osteopathy (DO) | Licensed providers similar to medical physicians but with different educational preparation and licensing exams. They provide care, prescribe, and can perform surgeries. |
| Dieticians | Assess, plan, implement, and evaluate interventions related to specific dietary needs of clients, including regular or therapeutic diets. Formulate diets for clients with dysphagia or other physical disorders and provide dietary education such as diabetes education. |
| Physical Therapists (PT) | Develop and implement a plan of care as a licensed professional for clients with dysfunctional physical abilities, including joints, strength, mobility, gait, balance, and coordination. |
| Occupational Therapists (OT) | Plan, provide, and evaluate care for clients with dysfunction affecting their independence and ability to complete activities of daily living (ADLs). Assist clients in using adaptive devices to reach optimal levels of functioning and provide home safety assessments. |
| Speech Therapists (ST) | Develop and initiate a plan of care for clients diagnosed with communication and swallowing disorders. |
| Respiratory Therapists (RT) | Specialize in treating clients with respiratory disorders or conditions in collaboration with providers. Provide treatments such as CPAP, BiPAP, respiratory treatments and medications like aerosol nebulizers, chest physiotherapy, and postural drainage. They also intubate clients, assist with bronchoscopies, manage mechanical ventilation, and perform pulmonary function tests. |
| Social Workers (SW) | Provide a liaison between the community and the health care setting to ensure continuity of care after discharge. Assist clients with establishing community resources, health insurance, and advance directives. |
| Psychologists and Psychiatrists | Provide mental health services to clients in both acute and long-term settings. As physician specialists, psychiatrists prescribe medications and perform other medical treatments for mental health disorders. Psychologists focus on counseling. |
| Nurse Case Managers or Discharge Planners | Ensure clients are provided with effective and efficient medical care and services, during inpatient care and post-discharge, while also managing the cost of these services. |
The coordination and delivery of safe, quality client care demands reliable teamwork and collaboration across the organizational and community boundaries. Clients often have multiple visits across multiple providers working in different organizations. Communication failures between health care settings, departments, and team members is the leading cause of client harm.[3] The health care system is becoming increasingly complex requiring collaboration among diverse health care team members. For example, when a COPD exacerbation client is discharged from the acute care setting, their condition may necessitate home resources or care in order to optimize their recovery. This may require the coordination of home oxygen resources, a walker, or home visits in order to assess their transition and recovery. Nurses must understand that community resources are individualized to their regional area and advocating for client needs and resource gaps is an important part of their role.
The goal of good interprofessional collaboration is improved client outcomes, as well as increased job satisfaction of health care team professionals. Clients receiving care with poor teamwork are almost five times as likely to experience complications or death. Hospitals in which staff report higher levels of teamwork have lower rates of workplace injuries and illness, fewer incidents of workplace harassment and violence, and lower turnover.[4]
Valuing and understanding the roles of team members are important steps toward establishing good interprofessional teamwork. Another step is learning how to effectively communicate with interprofessional team members.
Community Resource Care Coordination Case Scenario
Patient Background
Name: Mr. Gerald Hermso
Age: 72
Medical History: Chronic Heart Failure (CHF), Hypertension, Type 2 Diabetes, Hyperlipidemia
Recent Hospitalization: Mr. Hermso was admitted to the hospital due to a CHF exacerbation characterized by shortness of breath, fatigue, and fluid retention. After stabilization with diuretics, beta-blockers, and lifestyle adjustments, Mr. Hermso is ready for discharge.
Discharge Planning Goals:
- Ensure Mr. Hermso’s safe transition from hospital to home.
- Minimize the risk of readmission.
- Provide ongoing support for managing CHF at home.
Discharge Coordinator’s Role:
The discharge coordinator plays a crucial role in organizing Mr. Hermso’s transition from the hospital to his home. This includes identifying and coordinating community resources that can support his ongoing care.
- Assessment of Needs: The coordinator reviews Mr. Hermso’s medical records and discharge plan, including prescribed medications, follow-up appointments, dietary restrictions, and physical activity recommendations. The coordinator assesses Mr. Hermso’s living situation. Does he live alone? Does he have any support systems such as family or friends who can assist him? Identify any potential barriers to Mr. Hermso managing his condition at home, such as mobility issues, medication management challenges, or limited access to transportation.
- Collaboration with Nursing Staff: The discharge coordinator collaborates with the nurse assigned to Mr. Hermso to ensure all his needs are met. The nurse provides insights into Mr. Hermso’s physical and psychological readiness for discharge. Together, they develop a plan to address his needs post-discharge.
- Community Resources Identification: The discharge coordinator arranges for a home health nurse to visit Mr. Hermso several times a week to monitor his vital signs, administer medications, and provide education on CHF management. The coordinator sets up a service with a local pharmacy for medication delivery and synchronization, ensuring that Mr. Hermso receives his prescriptions on time. The nurse will teach Mr. Hermso how to use a pill organizer. A referral is made to a community dietitian who specializes in CHF to provide Mr. Hermso with personalized meal planning that aligns with his dietary restrictions. The coordinator arranges for Mr. Hermso to receive telehealth equipment, including a scale and blood pressure monitor, so that his weight and blood pressure can be monitored remotely. The nurse will educate Mr. Hermso on using this equipment. The coordinator refers Mr. Hermso to a local cardiac rehab program, where he can receive supervised exercise and education on heart health. If Mr. Hermso lacks transportation, the coordinator connects him with local transportation services that can take him to follow-up appointments and rehab sessions. The coordinator links Mr. Hermso with a local CHF support group where he can connect with others who have similar experiences, providing emotional and social support.
Nurse’s Role:
- Patient Education: The nurse provides detailed education on CHF management, including recognizing early signs of exacerbation, the importance of medication adherence, dietary restrictions (e.g., low-sodium diet), and the need for regular physical activity. The nurse teaches Mr. Hermso how to use his new telehealth equipment and ensures he understands how to log and report his readings.
- Care Coordination: The nurse ensures that all community resources are in place before discharge. This includes confirming home health services, medication delivery, and transportation arrangements. The nurse reviews the discharge plan with Mr. Hermso and his family (if applicable) to ensure they understand the follow-up schedule and how to access the resources provided.
- Follow-up: The nurse schedules a follow-up call within 48 hours of discharge to check on Mr. Hermso’s progress, answer any questions, and address any emerging issues.
Outcome:
- Immediate Post-Discharge: Mr. Hermso transitions home with a solid support system in place. He has access to home health services, medication management, dietary support, and telehealth monitoring.
- Long-term Monitoring: Through consistent follow-up and engagement with community resources, Mr. Hermso is better equipped to manage his CHF at home, reducing the likelihood of readmission and improving his overall quality of life.
- Interprofessional Education Collaborative. IPEC core competencies. https://www.ipecollaborative.org/ipec-core-competencies ↵
- Interprofessional Education Collaborative. IPEC core competencies. https://www.ipecollaborative.org/ipec-core-competencies ↵
- Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American Psychologist, 73(4), 433-450. https://doi.org/10.1037/amp0000298 ↵
- Rosen, M. A., DiazGranados, D., Dietz, A. S., Benishek, L. E., Thompson, D., Pronovost, P. J., & Weaver, S. J. (2018). Teamwork in healthcare: Key discoveries enabling safer, high-quality care. The American Psychologist, 73(4), 433-450. https://doi.org/10.1037/amp0000298 ↵
